Standard therapy for the majority of multiple sclerosis patients is escalation therapy. Induction therapy may be indicated for severe and active multiple sclerosis. The only two pharmacological agents that can be used for an induction approach are alemtuzumab and mitoxantrone because of their prolonged residual effect. Brain magnetic resonance imaging is a key examination for monitoring patients with relapsing-remitting multiple sclerosis.
Keywords: escalation induction multiple sclerosis treatment, escalation inductionmultiple sclerosistreatment
Extensive advances in multiple sclerosis treatment options have revolutionised multiple sclerosis treatment approaches. After a period when escalation therapy was considered the main option for relapsing-remitting multiple sclerosis, there is now increasing interest in using induction therapy in selected patients.
Widening of the therapeutic arsenal in multiple sclerosis opens up new perspectives bringing greater opportunity for personalised therapy. However, detailed guidelines, based on general consensus, that define treatment efficacy at the individual level have yet to be published. Randomised trials testing the benefit and safety of early induction therapy, and comparing escalation with induction therapy are warranted. Finally, the neurologist today faces new problems, including management of short- to long-term side effects, of treatment switches, and of pregnancy in patient of childbearing potential.
Funding / potential competing interests
Dr Théaudin received speaker honoraria from Genzyme and Merck, travel grant from Novartis and Biogen.
Marie Théaudin, MD PhD
Department of Neurology, CHUV, avenue du Bugnon 46, CH1011 Lausanne
1 Sormani MP, Gasperini C, Romeo M, Rio J, Calabrese M, Cocco E, et al. Assessing response to interferon-β in a multicenter dataset of patients with MS. Neurology. 2016;87:134–40.
2 Giovannoni G, Turner B, Gnanapavan S, Offiah C, Schmierer K, Marta M. Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Disord. 2015;4:329–33.
3 Barbin L, Rousseau C, Jousset N, Casey R, Debouverie M, Vukusic S, et al. Comparative efficacy of fingolimod vs natalizumab: A French multicenter observational study. Neurology. 2016;86:771–8.
4 Kalincik T, Brown JWL, Robertson N, Willis M, Scolding N, Rice CM, et al. Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in relapsing-remitting multiple sclerosis: a cohort study. Lancet Neurol. 2017;16:271–81.
5 Edan G, Le Page E. Induction therapy for patients with multiple sclerosis: why? When? How? CNS Drugs. 2013;27:403–9.
6 Edan G, Comi G, Le Page E, Leray E, Rocca MA, Filippi M, et al. Mitoxantrone prior to interferon beta-1b in aggressive relapsing multiple sclerosis: a 3-year randomised trial. J Neurol Neurosurg Psychiatry. 2011;82:1344–50.
7 Cohen JA, Coles AJ, Arnold DL, Confavreux C, Fox EJ, Hartung H-P, et al. Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial. Lancet. 2012;380:1819–28.
8 Wiendl H. Cladribine – an old newcomer for pulsed immune reconstitution in MS. Nat Rev Neurol. 2017;13:573–4.
9 Sormani MP, Muraro PA, Schiavetti I, Signori A, Laroni A, Saccardi R, et al. Autologous hematopoietic stem cell transplantation in multiple sclerosis: A meta-analysis. Neurology. 2017;88:2115–22.
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